For patients who have decided to have back surgery, taking time to prepare for the post-surgical recovery period is a good idea and will usually improve their experience when they get home. Presumably the treating physician and nursing staff will provide written discharge instructions and prescriptions for things like pain medication and physical therapy, but there are several practical things that patients and families should be aware of that should smooth the transition from hospital to home. The following summarizes several sensible points that patients and their families should find helpful.
If in Pain, Ask for Help
Appropriate pain management after surgery can really help with the recovery process - both from a physical and emotional standpoint. Narcotic pain pills, anti-inflammatory medications and Tylenol are commonly prescribed for postoperative pain. For patients who have just had a fusion surgery, NSAIDs (non-steroidal anti-inflammatory drugs) should be avoided as this class of drugs inhibits the formation of bone, a necessary component of creating the fusion.
Written instructions are usually provided which detail how to use these (often in combination) to control the pain effectively, while minimizing side effects such as constipation, nausea, and excessive sedation. Because postoperative constipation can be troublesome and a frequent cause of increased pain after surgery, ask the healthcare provider or pharmacist for names of recommended products to have on hand at home to prevent constipation or relieve it if it occurs. This problem is most common within the first week after surgery due to narcotic pain medications, change in diet and reduced activity.
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Patients who have been on chronic high dose narcotics will typically find it difficult to achieve adequate postoperative pain control using narcotics because they will have become tolerant to their effects. These patients will often need to try other means of controlling pain, such as application of ice or a cold pack, use of biofeedback and similar strategies to control the pain, and some may need to bear more pain than they would like.
Use Ice and Heat to Ease the Pain
Comfortable clothing and body positioning, and frequent ice application (especially in the first 48 to 72 hours) can also aid in pain management. Icing after activity such as walking and stretching can also be beneficial. Early on, the application of heat to the surgical area can increase blood flow to the tissues and may cause slight increase in swelling and pain so should instead be considered at a later point. Heat can be helpful early on to relieve tension or muscle pain in other regions of the body and might be worth trying. Often pain and stiffness will improve in response to frequent position change, or short walks either indoors or outdoors.
Getting enough continuous, uninterrupted sleep helps the body to heal faster. Minimizing low back strain through better body positioning can improve rest. It is generally OK after back surgery to sleep in whatever position is most comfortable. Some prefer to sleep on one side or the other with a pillow between their knees and/or behind them to support the back. Here is another position that takes stress off the low back:
- Lay face up on the bed
- Elevate the upper back/shoulder/head - this is easy to do with an adjustable bed, but can also be readily achieved on a regular mattress by using supportive pillows
- Place a pillow or rolled up blanket under the back of the knees, so the hips and knees are slightly bent.
Actively Participate in Rehabilitation
It bears repeating that patients should carefully follow their postoperative rehabilitation program. Appropriate exercise and stretching can significantly enhance the recovery process and decrease the chances of future episodes of pain. Exercise has the added benefit of helping foster an overall feeling of well-being for patients by increasing circulation and releasing endorphins, the body’s natural mood-enhancer.
- Stretch regularly. Patients should make sure that their treating physician and/or physical therapist provides recommendations and instruction on safe stretches that can be done following the surgery.
- Move regularly. Gentle, continuous movement helps circulate the blood, bringing valuable nutrients to the area. Patients should make sure that they understand any activity restrictions following the surgery (e.g. restrictions related to bending, lifting, twisting) and ask about which specific activities should be pursued or avoided (e.g. biking, walking, swimming, etc.)
Ask about Post-operative Bracing
It will be helpful to ask the surgeon IF a back brace will be needed after surgery and if so, what style. Some braces are simple elastic corsets while others are custom molded body jackets. If a larger brace is planned, it may be helpful to have some well-fitted cotton tee-shirts available that can be worn under the brace. The tee-shirts help the brace fit snugly against the skin with less irritation and they also help to absorb perspiration. For lumbar surgical procedures, the tee-shirt should be long enough to cover the upper part of the buttocks. Knowing the style of brace will help determine whether the patient can manage getting it on and off alone or whether they will need assistance on a regular basis.